| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $582.00 | $629.00 | $2,530.00 | |
Cigna
| Facility | AS | $171.20 | $171.20 | $171.20 |
Kaiser Permanente
| Professional | $1,508.28 | $1,843.51 | $2,571.84 | |
United
| Facility | $303.00 | $362.00 | $1,109.00 |